Vazquez Alejandro, Khan Mohemmed N, Govindaraj Satish, Baredes Soly, Eloy Jean Anderson
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Int Forum Allergy Rhinol. 2014 Aug;4(8):675-83. doi: 10.1002/alr.21332. Epub 2014 Apr 14.
Nasopharyngeal squamous cell carcinoma (NPSCC) is uncommon in non-endemic regions. Two major histologic subtypes are recognized: keratinizing (K-NPSCC) and nonkeratinizing (NK-NPSCC). We hypothesize that significant differences exist between the 2 in terms of demographic, clinicopathologic, survival, and prognostic features. We aim to show that differentiating between the 2 subtypes is perhaps the most important first step at the time of diagnosis.
Using a retrospective cohort design, the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was used to extract data on the 2 major subtypes of NPSCC. Frequency, incidence, and relative survival (RS) were analyzed comparatively. Regression analysis was conducted and hazard ratios (HRs) calculated.
A total of 1624 cases were identified: 1234 (76.0%) cases of NK-NPSCC and 390 (24.0%) cases of K-NPSCC. Five-year RS was 60.6% for NK-NPSCC and 40.5% for K-NPSCC. Regression analysis revealed K-NPSCC to be a poor prognostic factor (HR 2.1; 95% confidence interval, 1.8-2.6; p < 0.0001). Other factors associated with a poor prognosis included female gender in K-NPSCC, age greater than 44 years in both groups, and advanced-stage disease at diagnosis. Favorable prognostic factors included Asian/Pacific Islander race, and treatment with radiation therapy. Higher histologic grade did not portend a worse prognosis for either group.
NPSCC remains an uncommon malignancy in the United States. K-NPSCC and NK-NPSCC represent 2 different histologic entities with important clinical differences. K-NPSCC carries a worse overall prognosis when compared to NK-NPSCC.
鼻咽鳞状细胞癌（NPSCC）在非流行地区并不常见。主要有两种组织学亚型：角化型（K-NPSCC）和非角化型（NK-NPSCC）。我们假设这两种亚型在人口统计学、临床病理、生存和预后特征方面存在显著差异。我们旨在表明，在诊断时区分这两种亚型可能是最重要的第一步。
采用回顾性队列设计，利用美国国家癌症研究所的监测、流行病学和最终结果（SEER）登记处的数据，提取NPSCC两种主要亚型的数据。对频率、发病率和相对生存率（RS）进行比较分析。进行回归分析并计算风险比（HR）。
共识别出1624例病例：1234例（76.0%）为NK-NPSCC，390例（24.0%）为K-NPSCC。NK-NPSCC的五年相对生存率为60.6%，K-NPSCC为40.5%。回归分析显示K-NPSCC是一个不良预后因素（HR 2.1；95%置信区间，1.8 - 2.6；p < 0.0001）。其他与不良预后相关的因素包括K-NPSCC中的女性性别、两组中年龄大于44岁以及诊断时的晚期疾病。有利的预后因素包括亚洲/太平洋岛民种族以及放射治疗。较高的组织学分级对两组的预后均无不良影响。
NPSCC在美国仍然是一种罕见的恶性肿瘤。K-NPSCC和NK-NPSCC代表两种不同的组织学实体，具有重要的临床差异。与NK-NPSCC相比，K-NPSCC的总体预后更差。
